Accuracy of Emergency Physicians in Diagnosis of Thoracic Aortic Dissection; a Retrospective Study Examining the Incidence and Outcome of Patients with TAD

Abstract

Objective: This study is a retrospective study looking at the incidence, management and outcome of patients with thoracic aortic dissection, and the accuracy of emergency physicians in diagnosing thoracic aortic dissection. Background: Thoracic Aortic Dissection (TAD) is associated with a high mortality rate, more so if there is missed or late diagnosis (1-2% per hour). This makes the early diagnosis and prompt management a crucial component in mortality reduction. Methods: A retrospective cross-sectional data analysis of adults presenting to three Monash Health Emergency Departments (ED) suspected for TAD, over a 1-year period from 1st July 2018 to 30th June 2019. Through the presentations, patients with confirmed TAD were identified and demographics, management options as well as outcome were analysed. Results: 16045 adults presented to Monash health EDs with chest pain as their chief complaint over the study period. 68 had been investigated for TAD mainly with CT aortogram. 11 patients had a confirmed TAD (incidence rate of approximately 6.5 in 10000 patients per year), with majority (9 patients) being diagnosed with Stanford Type A dissection. Two patients died in the ED (mortality rate 18%) and others who survived were discharged home and stayed well in 3 months follow up. Conclusion: Thoracic aortic dissection, in particular Type A, remains a condition with a relatively high mortality rate. To reduce this, high index of suspicion and prompt investigation is essential. We demonstrated good accuracy and competency of Emergency physicians in diagnosing and screening for thoracic aortic dissection. Keywords: Aortic dissection; death; dissection; emergency department; TAD; Thoracic aortic dissection